Is Medicare coverage available for your home health care requirements?

If Medicare will pay for home care can be tricky. This is mostly because there’s a difference between “home care” and “home health care.” Also, what Medicare is supposed to cover doesn’t always match what you can get from home healthcare agencies and doctors.

David Lipschutz, who works at the Center for Medicare Advocacy, points out that there’s a big gap between what the law says Medicare can cover and what people can get.

If you’re feeling confused about all this, you’re not alone.

Lisa Harootunian, who helped write a report about Medicare and home health care, agrees that it’s a confusing topic for many people.

To help make things clearer and help you figure out how to get home health care with Medicare, here’s a simple guide:

What’s the difference between home health care and home care?

Home health care is something Medicare might pay for if you meet certain rules. It’s for medical services at home, like wound care or injections, usually after you’ve been in the hospital.

Home care, on the other hand, is more about helping you with everyday things like getting dressed or taking a bath. But remember, Medicare usually doesn’t cover long-term help like this.

Who can get Medicare to pay for home health care?

You can get Medicare to help pay for home health care if:

  • A doctor says you really need it and makes a care plan for you.
  • You need specific medical services.
  • You only need care for a short time, not all day.
  • You mostly stay at home (but you can still go out for short trips or special events).
  • A Medicare-approved agency gives you the care.

Even if you meet all these rules, finding a home healthcare agency can be tough. There aren’t as many as there used to be, and there’s a shortage of home health aides.

If you do find care, Medicare will cover most of the cost. You might have to pay 20% for medical equipment and meet your Part B deductible.

The reality of getting home health care with Medicare

Even though these are the rules, getting home health care through Medicare isn’t always easy. Some people are being told they can’t get coverage, even when the law says they should.

Experts think Medicare is starting to only cover short-term needs, like getting better at home after surgery. And even though the law says Medicare can help as long as you need it, it’s tough to get that level of care.

Changes in how Medicare pays for home health care have made things harder. Agencies might not offer as much help after the first 30 days because they get paid less.

If you have a Medicare Advantage plan, you might have more options for home health care, but some plans are cutting back on what they offer.

How to get home health care with Medicare

If you need help, there are resources:

  • Medicare’s guide and website can help you find and compare home health agencies.
  • Your State Health Insurance Assistance Program (SHIP) can answer questions.
  • The Eldercare Locator site and your local Area Agencies on Aging can give you more info.
  • Your doctor or hospital discharge planner can help you make a care plan and find an agency.

If you’re turned down for home health care but think you should get it, you can appeal the decision with Medicare or your Medicare Advantage plan.

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